Organ donation: With only a few govt hospitals, organ transplants still a distant dream for poor

November 26 is being observed as National Organ Donation Day experts and statistics point out that organ transplant program in the country is skewed in favour of private hospitals and thus in favour of those who can afford it

Out of 25 hospitals that carry out organ transplants, Sassoon Hospital is the only government hospital in Maharashtra which carries out liver transplants.

The staff of this govt hospital had taken an initiative to equip the govt medical college to cater to the poor and train aspiring transplant surgeons.

It’s been two months now that Sassoon General Hospital (SGH) became the first government run hospital to carry out liver transplant. Since then, a few patients approach the hospital each day, to enquire about two to three people are coming to inquire about both liver and organ transplants.

Out of 25 hospitals that carry out liver transplant there is only one government hospital in Maharashtra. Experts and statistics point out that organ transplant program in the country is skewed in favour of private hospitals and thus in favour of those who can afford it.

The Sassoon General Hospital, a state-run hospital from Pune, with 1296 beds, which does cadaveric liver and kidney transplants and has also applied for licence for heart transplants.

“We raised around 70 lakh through CSR for buying machinery for transplants. We have also asked National Organ and Tissue Transplant Organisation (NOTTO) to help us with funds so that we can start live liver transplant and not just cadaveric,” said Dr Ajay Chandanwale, dean of SGH.

Dr Bipin Vibhute, liver transplant surgeon from Pune, said, “The medical institutions in the country were not equipped to carry out transplants and so not equipped to train students. The picture has not changed much in the last one decade as there are very few government colleges who are doing transplants.”

“Once we have many more such cases, we plan to give fellowship for transplant procedures.” Said Chandanwale. When the current liver transplant procedure cost around 7 lakh at SGH, Chandanwale said that with more such cases the costs would come down. He also said that the government colleges will benefit more if the state government subsidises transplant procedures done at government hospitals.

Dr Sheetal Dhadphale, liver transplant surgeon at SGH, said, “When organ transplants are dominated by private hospitals it was needed to create an access for poor. It was this sheer need which made the entire team of around 200 staff members of SGH work hard to make transplant happen. The dean of the hospital accentuated all the departments to do it. There is no dearth of talent at the hospital and we involved every department of SGH.”

The team of doctors took a special training at private hospital in Pune. A special agency was deployed to take care of hygiene and cleanliness in the hospital. An exclusive infrastructure like bigger operation theatre and liver ICU was built. Additional training classes for the entire team were arranged.

“What is needed is to take that extra initiative and extra hard work for government staff. Teaching hospitals should be well equipped with all the treatment in order to be well equipped to train students,” said Dhadphale, who is the alma mater of SGH and had to go abroad to get trained as liver transplant surgeon.”

The Sassoon General Hospital has performed two liver transplants and 11 are on the waiting list, while it has performed 9 kidney transplants, and 27 are on the waiting list, for the same. Madhuri Sanas, daughter in law of Yashwant Sanas, said, “Yaswant Sanas is the second person to undergo a kliver transplant at Sasson Hospital in Pune,

“We would have been indebted as it would have had taken us rupees 25 lakh to get it done at a private hospital. We had lost all the hope until it was made available at the government hospital.”

Shankar Malekar, a landless labourer hailing from a small village in Bhor district of Maharashtra, and who is in the process of registering name of his wife at the SGH, said, “I want it to get done for my wife. She has only two options either to get it done at the SGH or die, because i cannot afford private hospitals.”

The families of brain-dead do want to know whether the organs will go to a patient who is unable to afford transplant. Different media reports on hospitals getting involved into organ rackets also raises doubt about altruistic motive of these private hospitals in the minds of family members.

Surekha Joshi, medical social worker and counsellor at Ruby Hall clinic, Pune, said, “We do get question called who will get these organs? Will it go to poor? We just say that it goes to the needy patient who will otherwise die without an organ.”

But all the counsellors silently accept the anomaly that regardless of who donates an organ, rich or poor, the organ will go to private hospitals and so will benefit the rich.

Dr Sanjay Nagral from Jaslok Hospital Mumbai, who has published a paper in the journal of Clinical and Experimental Hepatology underlining how transplant program is not socio-economically inclusive in India and how it is dominated by private sector, said, “We might think that at least some people get saved; (or that) at least rich or the middle class patients can be saved. But this may not be socially acceptable.”

“To go to the people at large and ask them to donate organs and still have a situation where in the same people may not be able to get transplants because of the cost is a disturbing situation. All that government needs to do is identify 25 centres across India – at post graduate medical teaching institutes or government hospitals – and make them centres of excellence in transplants,” he added.